2-Polycyclic propynyl adenosine analogs having A2A agonist activity

ABSTRACT

The invention provides compounds having the following general formula (I):  
                 
 
     wherein X, R 1 , R 2 , R 7  and Z are as described herein.

RELATED APPLICATIONS

This application claims priority from a provisional application entitled: “2-POLYCYCLIC PROPYNYL ADENOSINE ANALOGS HAVING A2A AGONIST ACTIVITY AND COMPOSITIONS THEREOF”, filed on Aug. 2, 2004, Ser. No. 60/598,025, the entire contents of which is included herein by reference.

GOVERNMENT FUNDING

The invention described herein was made with government support under Grant Number R01 HL37942, awarded by the National Science Foundation. The United States Government has certain rights in the invention.

BACKGROUND OF THE INVENTION

The inflammatory response serves the purpose of eliminating harmful agents from the body. There is a wide range of pathogenic insults that can initiate an inflammatory response including infection, allergens, autoimmune stimuli, immune response to transplanted tissue, noxious chemicals, and toxins, ischemia/reperfusion, hypoxia, mechanical and thermal trauma. Inflammation normally is a very localized action which serves in expulsion, attenuation by dilution, and isolation of the damaging agent and injured tissue. The body's response becomes an agent of disease when it results in inappropriate injury to host tissues in the process of eliminating the targeted agent, or responding to a traumatic insult.

As examples, inflammation is a component of pathogenesis in several vascular diseases or injuries. Examples include: ischemia/reperfusion injury (N. G. Frangogiannis et al., in Myocardial Ischemia: Mechanisms Reperfusion, Protection, M. Karnazyn, ed., Birkhuser Verlag (1996) at 236-284; H. S. Sharma et al., Med. of Inflamm., 6, 175 (1987)), atherosclerosis (R. Ross, Nature, 362, 801 (1993)), inflammatory aortic aneurysms (N. Girardi et al., Ann. Thor. Surg., 64, 251 (1997); D. I. Walker et al., Brit. J. Surg., 59, 609 (1972); R. L. Pennell et al., J. Vasc. Surg., 2, 859 (1985)), and restenosis following balloon angioplasty (see, R. Ross cited above). The cells involved with inflammation include leukocytes (i.e., the immune system cells—neutrophils, eosinophils, lymphocytes, monocytes, basophils, macrophages, dendritic cells, and mast cells), the vascular endothelium, vascular smooth muscle cells, fibroblasts, and myocytes.

The release of inflammatory cytokines such as tumor necrosis factor-alpha (TNFα) by leukocytes is a means by which the immune system combats pathogenic invasions, including infections. TNFα stimulates the expression and activation of adherence factors on leukocytes and endothelial cells, primes neutrophils for an enhanced inflammatory response to secondary stimuli and enhances adherent neutrophil oxidative activity. See, Sharma et al., cited above. In addition, macrophages/dendritic cells act as accessory cells processing antigen for presentation to lymphocytes. The lymphocytes, in turn, become stimulated to act as pro-inflammatory cytotoxic cells.

Generally, cytokines stimulate neutrophils to enhance oxidative (e.g., superoxide and secondary products) and non-oxidative (e.g., myeloperoxidase and other enzymes) inflammatory activity. Inappropriate and over-release of cytokines can produce counterproductive exaggerated pathogenic effects through the release of tissue-damaging oxidative and non-oxidative products (K. G. Tracey et al., J. Exp. Med., 167, 1211 (1988); and D. N. Mannel et al., Rev. Infect. Dis., 9 (suppl. 5), S602-S606 (1987)). For example, TNFα can induce neutrophils to adhere to the blood vessel wall and then to migrate through the vessel to the site of injury and release their oxidative and non-oxidative inflammatory products.

Although monocytes collect slowly at inflammatory foci, given favorable conditions, the monocytes develop into long-term resident accessory cells and macrophages. Upon stimulation with an inflammation trigger, monocytes/macrophages also produce and secrete an array of cytokines (including TNFα), complement, lipids, reactive oxygen species, proteases and growth factors that remodel tissue and regulate surrounding tissue functions.

For example, inflammatory cytokines have been shown to be pathogenic in: arthritis (C. A. Dinarello, Semin. Immunol., 4, 133 (1992)); ischemia (A. Seekamp et al., Agents-Actions-Supp., 41, 137 (1993)); septic shock (D. N. Männel et al., Rev. Infect. Dis., 9 (suppl. 5), S602-S606 (1987)); asthma (N. M. Cembrzynska et al., Am. Rev. Respir. Dis., 147, 291 (1993)); organ transplant rejection (D. K. Imagawa et al., Transplantation, 51, 57 (1991); multiple sclerosis (H. P. Hartung, Ann. Neurol., 33, 591 (1993)); AIDS (T. Matsuyama et al., AIDS, 5, 1405 (1991)); and in alkali-burned eyes (F. Miyamoto et al., Opthalmic Res., 30, 168 (1997)). In addition, superoxide formation in leukocytes has been implicated in promoting replication of the human immunodeficiency virus (HIV) (S. Legrand-Poels et al., AIDS Res. Hum. Retroviruses, 6, 1389 (1990)).

It is well known that adenosine and some analogs of adenosine that non-selectively activate adenosine receptor subtypes decrease neutrophil production of inflammatory oxidative products (B. N. Cronstein et al., Ann. N.Y. Acad. Sci., 451, 291 (1985); P. A. Roberts et al., Biochem. J., 227, 669 (1985); D. J. Schrier et al., J. Immunol., 137, 3284 (1986); B. N. Cronstein et al., Clinical Immunol. and Immunopath., 42, 76 (1987); M. A. Iannone et al., in Topics and Perspective in Adenosine Research, E. Gerlach et al., eds., Springer-Verlag, Berlin, p. 286 (1987); S. T. McGarrity et al., J. Leukocyte Biol., 44, 411421 (1988); J. De La Harpe et al., J. Immunol., 143, 596 (1989); S. T. McGarrity et al., J. Immunol., 142, 1986 (1989); and C. P. Nielson et al., Br. J. Pharmacol., 97, 882 (1989)). For example, adenosine has been shown to inhibit superoxide release from neutrophils stimulated by chemoattractants such as the synthetic mimic of bacterial peptides, f-met-leu-phe (fMLP), and the complement component C₅a (B. N. Cronstein et al., J. Immunol., 135, 1366 (1985)). Adenosine can decrease the greatly enhanced oxidative burst of PMN (neutrophil) first primed with TNF-α and then stimulated by a second stimulus such as f-met-leu-phe (G. W. Sullivan et al., Clin. Res., 41, 172A (1993)). Additionally, it has been reported that adenosine can decrease the rate of HIV replication in a T-cell line (S. Sipka et al., Acta. Biochim. Biopys. Hung., 23, 75 (1988)). However, there is no evidence that in vivo adenosine has anti-inflammatory activity (G. S. Firestein et al., Clin. Res., 41, 170A (1993); and B. N. Cronstein et al., Clin. Res., 41, 244A (1993)).

It has been suggested that there is more than one subtype of adenosine receptor on neutrophils that can have opposite effects on superoxide release (B. N. Cronstein et al. J. Clin. Invest., 85, 1150 (1990)). The existence of A_(2A) receptor on neutrophils was originally demonstrated by Van Calker et al. (D. Van Calker et al., Eur. J. Pharmacology, 206, 285 (1991)).

There has been progressive development of compounds that are more and more potent and/or selective as agonists of A_(2A) adenosine receptors (AR) based on radioligand binding assays and physiological responses. Initially, compounds with little or no selectivity for A_(2A) receptors were developed, such as adenosine itself or 5′-carboxamides of adenosine, such as 5′-N-ethylcarboxamidoadenosine (NECA) (B. N. Cronstein et al., J. Immunol., 135, 1366 (1985)). Later, it was shown that addition of 2-alkylamino substituents increased potency and selectivity, e.g., CV1808 and CGS21680 (M. F. Jarvis et al., J. Pharmacol. Exp. Ther., 251, 888 (1989)). 2-Alkoxy-substituted adenosine derivatives such as WRC-0090 are even more potent and selective as agonists at the coronary artery A_(2A) receptor (M. Ueeda et al., J. Med. Chem., 34, 1334 (1991)). The 2-alklylhydrazino adenosine derivatives, e.g., SHA 211 (also called WRC-0474) have also been evaluated as agonists at the coronary artery A2A receptor (K. Niiya et al., J. Med. Chem., 35, 4557 (1992)).

There is one report of the combination of relatively nonspecific adenosine analogs, R-phenylisopropyladenosine (R-PIA) and 2-chloroadenosine (Cl-Ado) with a phosphodiesterase (PDE) inhibitor resulting in a lowering of neutrophil oxidative activity (M. A. Iannone et al., Topics and Perspectives in Adenosine Research, E. Garlach et al., eds., Springer-Verlag, Berlin, pp. 286-298 (1987)). However, R-PIA and Cl-Ado analogs are actually more potent activators of A₁ adenosine receptors than of A_(2A) adenosine receptors and, thus, are likely to cause side effects due to activation of A₁ receptors on cardiac muscle and other tissues causing effects such as “heart block.”

R. A. Olsson et al. (U.S. Pat. No. 5,278,150) disclose selective adenosine A₂ receptor agonists of the formula:

wherein Rib is ribosyl, R₁ can be H and R₂ can be cycloalkyl. The compounds are disclosed to be useful for treating hypertension, atherosclerosis and as vasodilators.

Olsson et al. (U.S. Pat. No. 5,140,015) disclose certain adenosine A₂ receptor agonists of formula:

wherein C(X)BR₂ can be CH₂OH and R₁ can be alkyl- or alkoxyalkyl. The compounds are disclosed to be useful as vasodilators or an antihypertensive.

Linden et al. (U.S. Pat. No. 5,877,180) is based on the discovery that certain inflammatory diseases, such as arthritis and asthma, may be effectively treated by the administration of compounds which are selective agonists of A_(2A) adenosine receptors, preferably in combination with a Type IV phosphodiesterase inhibitor. An embodiment of the Linden et al. invention provides a method for treating inflammatory diseases by administering an effective amount of an A_(2A) adenosine receptor of the following formula:

wherein R and X are as described in the patent.

In one embodiment, the Linden et al. invention involves the administration of a Type IV phosphodiesterase (PDE) inhibitor in combination with the A_(2A) adenosine receptor agonist. The Type IV phosphodiesterase (PDE) inhibitor includes racemic and optically active 4-(polyalkoxyphenyl)-2-pyrrolidones of the following formula:

wherein R′, R¹⁸, R¹⁹ and X are as disclosed and described in U.S. Pat. No. 4,193,926. Rolipram is an example of a suitable Type IV PDE inhibitor included within the above formula.

G. Cristalli (U.S. Pat. No. 5,593,975) discloses 2-arylethynyl, 2-cycloalkylethynyl or 2-hydroxyalkylethynyl derivatives, wherein the riboside residue is substituted by carboxy amino, or substituted carboxy amino (R₃HNC(O)—). 2-Alkynylpurine derivatives have been disclosed in Miyasaka et al. (U.S. Pat. No. 4,956,345), wherein the 2-alkynyl group is substituted with (C₃-C₁₆)alkyl. The '975 compounds are disclosed to be vasodilators and to inhibit platelet aggregation, and thus to be useful as anti-ischemic, anti-atherosclerosis and anti-hypertensive agents.

Recently, U.S. Pat. No. 6,232,297 to Linden, et al. disclosed compounds having the general formula:

wherein each R is H, X is ethylaminocarbonyl and R¹ is 4-carboxycyclo-hexylmethyl (DWH-146a), R¹ is 4-methoxycarbonylcyclohexylmethyl (DWH-146e) or R¹ is 4-acetoxymethyl-cyclohexylmethyl (JMR-193). These compounds are reported to be A_(2A) agonists.

However, a continuing need exists for selective A₂ adenosine receptor agonists useful for therapeutic applications, which have reduced side effects. In addition, a continuing need exists for selective A2 adenosine receptor agonists useful for use as pharmacological stressors in stress imaging or in other ventricular function imaging techniques, that preferably have reduced side effects, while being chemically stable and short-acting.

SUMMARY OF THE INVENTION

The present invention comprises compounds and methods of their use for the treatment of inflammatory activity in mammalian tissue. The inflammatory tissue activity can be due to pathological agents or can be due to physical, chemical or thermal trauma, or the trauma of medical procedures, such as organ, tissue or cell transplantation, angioplasty (PCTA), inflammation following ischemia/reperfusion, or grafting. The present compounds comprise a novel class of 2-alkynyladenosine derivatives, substituted at the ethyn-2-yl position with specific polycyclic moieties. Preferably, the riboside residue is substituted at the 5′-position by an N-alkylcarboxyamino (“aminocarbonyl”) moiety (“X”). Thus, the present invention provides a method for inhibiting the inflammatory response in a mammal, such as a human subject, and protecting the tissue subject to the response, by administering an effective amount of one or more compounds of the invention.

The compounds of the invention have general formula (I):

wherein each R¹ is independently hydrogen, halo, —OR^(a), —SR^(a), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₃-C₈)cycloalkyl, heterocycle, heterocycle(C₁-C₈)alkylene-, aryl, aryl(C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, —CO₂R^(a), R^(a)C(═O)O—, R^(a)C(═O)—, —OCO₂R^(a), R^(a)R^(b)NC(═O)O—, R^(b)OC(═O)N(R^(a))—, R^(a)R^(b)N—, R^(a)R^(b)NC(═O)—, R^(a)C(═O)N(R^(b))—, R^(a)R^(b)NC(═O)N(R^(b))—, R^(a)R^(b)NC(═S)N(R^(b)), —OPO₃R^(a), R^(a)OC(═S)—, R^(a)C(═S)—, —SSR^(a), R^(a)S(═O)—, R^(a)S(═O)₂—, —N═NR^(a), or —OPO₂R^(a);

-   -   each R² is independently hydrogen, halo, (C₁-C₈)alkyl,         (C₃-C₈)cycloalkyl, or     -   R₁ and R₂ and the atom to which they are attached is C═O, C═S or         C═NR^(c);     -   Z is

wherein each Z group is optionally substituted with from 1 to 10 R⁶ groups;

each R⁶ is independently halo, —OR^(a), —SR^(a), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₁-C₈)cycloalkyl, (C₁-C₈)cycloalkyl-(C₁-C₈)alkylene-, (C₆-C₁₂)bicycloalkyl, heterocycle or heterocycle (C₁-C₈)alkylene-, aryl, aryl (C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, —CO₂R^(a), R^(a)C(═O)O—, R^(a)C(═O), —OCO₂R^(a), R^(a)R^(b)NC(═O)O—, R^(b)OC(═O)N(R^(a))—, R^(a)R^(b)N—, R^(a)R^(b)NC(═O)—, R^(a)C(═O)N(R^(b))—, R^(a)R^(b)NC(═O)N(R^(b))—, R^(a)R^(b)NC(═S)N(R^(b)—, —OPO) ₃R^(a), R^(a)OC(═S)—, R^(a)C(═S)—, —SSR^(a), R^(a)S(═O)—, —NNR^(a), —OPO₂R^(a), or two R⁶ groups and the atom to which they are attached is C═O, C═S; or two R⁶ groups together with the atom or atoms to which they are attached can form a carbocyclic or a heterocyclic ring comprising from 1 to 6 carbon atoms and 1, 2, 3, or 4 heteroatoms selected from non-peroxide oxy (—O—), thio (—S—), sulfinyl (—SO—), sulfonyl (—S(O)₂—), phosphine (—OP(O)₂—, or amine (—NR^(a)—) in the ring;

each R⁷ is independently hydrogen, (C₁-C₈)alkyl, (C₃-C₈)cycloalkyl, aryl or aryl(C₁-C₈)alkylene, heteroaryl, heteroaryl(C₁-C₈)alkylene-;

X is —CH₂OR^(a), —CO₂R^(a), —CH₂OC(O)R^(a), —C(O)NR^(a)R^(b), —CH₂SR^(a), —C(S)OR^(a), —CH₂OC(S)R^(a) or C(S)NR^(a)R^(b) or —CH₂N(R^(a))(R^(b));

wherein any of the alkyl, alkenyl, cycloalkyl, cycloalkenyl, heterocycle, aryl, or heteroaryl, groups of R¹, R², R⁶ and R⁷ is optionally substituted on carbon with one or more (e.g. 1, 2, 3, or 4) substituents selected from the group consisting of halo, —OR^(f), —SR^(f), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₃-C₈)cycloalkyl, (C₆-C₁₂)bicycloalkyl, heterocycle or heterocycle(C₁-C₈)alkylene-, aryl, aryloxy, aryl (C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, —CO₂R^(f), R^(f)C(═O)O—, R^(f)C(═O)—, —OCO₂R^(f), R^(f)R^(g)NC(═O)O—, R^(g)OC(═O)N(R^(f))—, R^(f)R^(g)N—, R^(f)R^(g)NC(═O)—, R^(f)C(═O)N(R^(g))—, R^(f)R^(g)NC(═O)N(R^(g))—, R^(f)R^(g)NC(═S)N(R^(g))—, —OPO₃R^(f), R^(f)OC(═S)—, R^(f)C(═S)—, —SSR^(f), R^(f)S(═O)_(p)—, R^(f)R^(g)NS(O)_(p)—, N═NR^(f), and —OPO₂R^(f);

wherein any (C₁-C₈)alkyl, (C₃-C₈)cycloalkyl, (C₆-C₁₂)bicycloalkyl, (C₁-C₈)alkoxy, (C₁-C₈)alkanoyl, (C₁-C₈)alkylene, or heterocycle, is optionally partially unsaturated;

R^(a) and R^(b) are each independently hydrogen, (C₁-C₈)alkyl, or (C₁-C₈)alkyl substituted with 1-3 (C₁-C₈)alkoxy, (C₃-C₈)cycloalkyl, (C₁ -C₈)alkylthio, aryl, aryl(C₁-C₈)alkylene, heteroaryl, or heteroaryl(C₁-C₈)alkylene; or R^(a) and R^(b), together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring;

R^(f) and R^(g) are each independently hydrogen, (C₁-C₈)alkyl, or (C₁-C₈)alkyl substituted with 1-3 (C₁-C₈)alkoxy, (C₃-C₈)cycloalkyl, (C₁-C₈)alkylthio, aryl, aryl(C₁-C₈)alkylene, heteroaryl, or heteroaryl(C₁-C₈)alkylene; or R^(f) and R^(g), together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring; and

R^(c) is hydrogen or (C₁-C₆)alkyl; m is 0, 1, 2, 3, 4, 5, 6, 7, or 8 and p is 1, or 2; or a pharmaceutically acceptable salt thereof.

The invention provides a compound of formula I for use in medical therapy, preferably for use in treating inflammation or protecting mammalian tissue from inflammation such as an inflammatory response, e.g., resulting from allergy, trauma or ischemia/reperfusion injury, as well as the use of a compound of formula I for the manufacture of a medicament for the treatment of an inflammatory response due to a pathological condition or symptom in a mammal, such as a human, which is associated with inflammation.

The invention also includes the use of a combination of these compounds With type IV phosphodiesterase inhibitors to preferably cause synergistic decreases in the inflammatory response mediated by leukocytes.

The invention also provides a pharmaceutical composition comprising an effective amount of the compound of formula I, or a pharmaceutically acceptable salt thereof, in combination with a pharmaceutically acceptable diluent or carrier, and optionally, in combination with a Type IV phosphodiesterase (PDE) inhibitor. Preferably, the composition is presented as a unit dosage form.

Additionally, the invention provides a therapeutic method for preventing or treating a pathological condition or symptom in a mammal, such as a human or equine, wherein the activity of A_(2A) adenosine receptors is implicated and agonism of said receptors is desired, comprising administering to a mammal in need of such therapy, an effective amount of a compound of formula I, or a pharmaceutically acceptable salt thereof. It is believed that activation of A_(2A) adenosine receptors inhibits inflammation by affecting neutrophils, mast cells, monocytes/macrophages, platelets T-cells and/or eosinophils. Inhibition of these inflammatory cells results in tissue protection following tissue insults.

In addition, the present invention provides a therapeutic method for treating biological diseases that includes the administration of an effective amount of a suitable antibiotic agent, antifungal agent or antiviral agent in conjunction with an A_(2A) adenosine receptor agonist. If no anti-pathogenic agent is known the A_(2A) agonist can be used alone to reduce inflammation, as may occur during infection with antibiotic resistant bacteria, or certain viruses such as those that cause SARS or Ebola. Optionally, the method includes administration of a type IV PDE inhibitor. The A_(2A) adenosine receptor agonist can provide adjunctive therapy for treatment conditions such as, the inflammation, caused by sepsis, for example, human uremic syndrome when administered with antibiotics in the treatment of bio-terrorism weapons, such as anthrax, tularemia, Escherichia coli, plague and the like. The present invention also provides adjunctive therapy for treatment of lethal bacterial, fungal and viral infections such as anthrax, tularemia, escherichia and plague comprising administration of an antibacterial agent, an antifungal agent or an antiviral agent in conjunction with selective, A_(2A) adenosine receptor agonists.

The present invention provides compounds and methods of their use for detecting the presence of, and assessing the severity of, coronary artery stenoses in a mammal, such as a human or domestic animal. Preferably, the compounds of the invention are used as pharmacological stress-inducing agents or stressors that are useful in pharmacological stress imaging for the detection and assessment of coronary artery disease. The specific compounds of the invention useful as stress-inducing agents are potent and selective at A_(2A) adenosine receptors, but are also short-acting, so that they are rapidly cleared by the body following the imaging process.

Thus, the present invention provides a method for detecting the presence and severity of coronary artery stenoses in a mammal, such as a human subject, comprising (1) administering an amount of one or more compounds of the general formula (I) and (2) performing a technique on said mammal to detect and/or determine the severity of said coronary artery stenoses.

The invention provides a compound of formula (I) for use in medical diagnostic procedures, preferably for use in detecting the presence of, and assessing the severity of, coronary artery stenoses in a human subject. The present invention provides the use of a compound of formula (I) for the manufacture of a pharmacologic vasodilator agent which could be used with clinical perfusion imaging techniques for diagnosing and assessing the extent of coronary artery disease. Preferred perfusion imaging techniques are planar or single photon emission computed tomography (SPECT) gamma camera scintigraphy, positron emission tomography (PET), nuclear magnetic resonance (NMR) imaging, perfusion contrast echocardiography, digital subtraction angiography (DSA) and ultrafast X-ray computed tomography (CINE CT).

The invention also provides a pharmaceutical composition comprising an effective amount of the compound of formula (I), or a pharmaceutically acceptable salt thereof, in combination with a pharmaceutically acceptable diluent or carrier. Preferably, the composition is presented as a unit dosage form, and can be adapted for parenteral, e.g., intravenous infusion.

The present invention provides a therapeutic method for treating biological diseases that provoke inflammation either alone or in combination with a disease killing medicine. These include bacteria in combination with antibiotics, including but not limited to bacteria that cause anthrax, tularemia, plague, lyme disease and anthrax. Also included are viruses including but not limited to those that cause RSV, severe acute respiratory syndrome (SARS), influenza and Ebola with or without anti-viral therapy. Also included are yeast and fungal infections with or without anti-yeast or anti-fungal agents.

The antibacterial agent, antifungal agent or antiviral agent can be co-administered (e.g., simultaneously) with the A_(2A) adenosine receptor agonist or they can be can be administered either simultaneously or as a mixture or they can be administered subsequently. The subsequent administration of the A_(2A) adenosine receptor agonists can be prior to the agent, within minutes or up to about 48 hours after the administration of the agent. Preferably the administration of the A_(2A) adenosine receptor agonists will be within about 24 hours and more preferably within about 12 hours.

The method of the invention will also be useful for treating patients with sepsis, severe sepsis, and potentially, the systemic inflammatory response syndrome, in addition to septic shock. The A_(2A)AR agonists exert multiple anti-inflammatory effects early in the inflammatory cascade, and thus a short course of an A_(2A)AR agonists could produce profound benefit in serious, life-threatening infectious and inflammatory disorders of humans, including inhalational anthrax, tularemia, escherichia and plague.

The anti-inflammatory effect of A_(2A)AR agonists has been documented in vivo, in experimental models of meningitis, peritonitis and arthritis. The potentially fatal syndrome of bacterial sepsis is an increasingly common problem in acute care units. Sepsis and septic shock, now the eleventh leading cause of death in the United States, are increasing in frequency. Current estimates indicate that about 900,000 new cases of sepsis (approximately 60% Gram negative) occur in the United States annually with an estimated crude mortality rate of 35%. Furthermore, the mortality rate, as assessed in recent clinical trials, is approximately 25%, while approximately 10% of patients die from their underlying disease. Shock develops in approximately 200,000 cases annually with an attributable mortality rate of 46% (92,000 deaths). Sepsis accounts for an estimated $5-10 billion annually in health care expenditures. It is now widely appreciated that among hospitalized patients in non-coronary intensive care units, sepsis is the most common cause of death. Sepsis syndrome is a public health problem of major importance. A_(2A)AR agonists are anticipated to have use as a new and unique adjunctive therapeutic approach to reduce morbidity and mortality. It is believed that this treatment will improve the outcome in systemic anthrax, tularemia, escherichia and plague.

The agonists of A_(2A) adenosine receptors of the invention can inhibit neutrophil, macrophage and T cell activation and thereby reduce inflammation caused by bacterial and viral infections. The compounds, in conjunction with antibiotics or antiviral agents can prevent or reduce mortality caused by sepsis or hemolytic uremic syndrome or other inflammatory conditions. The effects of adenosine A_(2A) agonists are enhanced by type IV phosphodiesterase inhibitors such as rolipram.

The invention also provides a compound of formula I for use in medical therapy (e.g., for use as an adjunct in the treatment of potentially lethal bacterial infections, such as, anthrax, tularemia, Escherichia, plague, or other bacterial or viral infections, and treatment of systemic intoxification caused by bacterial and/or viral infections, as well as the use of a compound of formula I for the manufacture of a medicament for reducing inflammation caused by the bacteria or virus or the treatment thereof in a mammal, such as a human. The compounds of the invention are also useful for treatment of treating systemic intoxification wherein the bacterial or viral agents cause inflammation either directly or as a result of treatment, e.g., with an antibiotic or antiviral agent.

Sepsis is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing bacteria or viruses. The infection, which can manifest as inflammation, can be caused by the bacteria or virus pathogens directly or from the treatment thereof, i.e., the death of the pathogens due to treatment with antibacterial or antiviral agents. Sepsis can be also be viewed as the body's response to an infection. The infection can be caused by microorganisms or “germs” (usually bacteria) invade the body, can be limited to a particular body region (e.g., a tooth abscess) or can be widespread in the bloodstream (often referred to as “septicemia” or “blood poisoning”)

The systemic intoxification or inflammatory shock is often referred to as Septic shock; Bacteremic shock; Endotoxic shock; Septicemic shock; or Warm shock.

Septic shock is a serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Vital organs, such as the brain, heart, kidneys, and liver may not function properly or may fail. Septic shock occurs most often in the very old and the very young. It also occurs in people with underlying illnesses. Any bacterial organism can cause septic shock. Fungi and viruses may also cause this condition. Toxins released by the bacteria, fungi or viruses may cause direct tissue damage, and may lead to low blood pressure and/or poor organ function. These toxins can also produce a vigorous inflammatory response from the body, which contributes to septic shock.

In another aspect, the present invention also provides a method to treat severe acute respiratory syndrome (SARS), comprising administering to a mammal in need of said therapy, an effective anti-inflammatory amount of an agonists of A_(2A) adenosine receptor, optionally with a PDE-IV inhibitor, such as, rolipram.

BRIEF DESCRIPTION OF THE FIGURE

FIG. 1 is an illustration of the duration of action of A_(2A) agonists by monitoring the reduction of blood pressure in rats after administration of compounds of the present invention compared with other A_(2A) agonists.

DETAILED DESCRIPTION OF THE INVENTION

The following definitions are used, unless otherwise described. Halo is fluoro, chloro, bromo, or iodo. Alkyl, alkoxy, aralkyl, alkylaryl, etc. denote both straight and branched alkyl groups; but reference to an individual radical such as “propyl” embraces only the straight chain radical, a branched chain isomer such as “isopropyl” being specifically referred to. Aryl includes a phenyl radical or an ortho-fused bicyclic carbocyclic radical having about nine to ten ring atoms in which at least one ring is aromatic. Heteroaryl encompasses a radical attached via a ring carbon of a monocyclic aromatic ring containing five or six ring atoms consisting of carbon and one to four heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(X) wherein X is absent or is H, O, (C₁-C₄)alkyl, phenyl or benzyl, as well as a radical of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto.

It will be appreciated by those skilled in the art that the compounds of formula (I) have more than one chiral center and may be isolated in optically active and racemic forms. Preferably, the riboside moiety of formula (I) is derived from D-ribose. Some compounds may exhibit polymorphism. It is to be understood that the present invention encompasses any racemic, optically-active, polymorphic, or stereoisomeric form, or mixtures thereof, of a compound of the invention, which possess the useful properties described herein, it being well known in the art how to prepare optically active forms (for example, by resolution of the racemic form by recrystallization techniques, or enzymatic techniques, by synthesis from optically-active starting materials, by chiral synthesis, or by chromatographic separation using a chiral stationary phase) and how to determine adenosine agonist activity using the tests described herein, or using other similar tests which are well known in the art.

Among the inflammatory responses that can be treated (including treated prophylactically) with a compound of formula I, optionally with a Type IV PDE inhibitor, are inflammation due to:

(a) autoimmune stimulation (autoimmune diseases), such as lupus erythematosus, multiple sclerosis, infertility from endometriosis, type I diabetes mellitus including the destruction of pancreatic islets leading to diabetes and the inflammatory consequences of diabetes, including leg ulcers, Crohn's disease, ulcerative colitis, inflammatory bowel disease, osteoporosis and rheumatoid arthritis;

(b) allergic diseases such as asthma, hay fever, rhinitis, poison ivy, vernal conjunctivitis and other eosinophil-mediated conditions;

(c) skin diseases such as psoriasis, contact dermatitis, eczema, infectious skin ulcers, healing of open wounds, cellulitis;

(d) infectious diseases including sepsis, septic shock, encephalitis, infectious arthritis, endotoxic shock, gram negative shock, Jarisch-Herxheimer reaction, anthrax, plague, tularemia, ebola, shingles, toxic shock, cerebral malaria, bacterial meningitis, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), lyme disease, HIV infection, (TNFα-enhanced HIV replication, TNFα inhibition of reverse transcriptase inhibitor activity);

(e) wasting diseases: cachexia secondary to cancer and HIV;

(f) organ, tissue or cell transplantation (e.g., bone marrow, cornea, kidney, lung, liver, heart, skin, pancreatic islets) including transplant rejection, and graft versus host disease;

(g) adverse effects from drug therapy, including adverse effects from amphotericin B treatment, adverse effects from immunosuppressive therapy, e.g., interleukin-2 treatment, adverse effects from OKT3 treatment, contrast dyes, antibiotics, adverse effects from GM-CSF treatment, adverse effects of cyclosporine treatment, and adverse effects of aminoglycoside treatment, stomatitis and mucositis due to immunosuppression;

(h) cardiovascular conditions including circulatory diseases induced or exasperated by an inflammatory response, such as ischemia, atherosclerosis, peripheral vascular disease, restenosis following angioplasty, inflammatory aortic aneurysm, vasculitis, stroke, spinal cord injury, congestive heart failure, hemorrhagic shock, ischemia/reperfusion injury, vasospasm following subarachnoid hemorrhage, vasospasm following cerebrovascular accident, pleuritis, pericarditis, and the cardiovascular complications of diabetes;

(i) dialysis, including pericarditis, due to peritoneal dialysis;

(j) gout; and

(k) chemical or thermal trauma due to burns, acid, alkali and the like.

Of particular interest and efficacy is the use of the present compounds to limit inflammatory responses where the ischemia/reperfusion injury is caused by angioplasty or throbolysis. Also of particular interest and efficacy is the use of the present compounds to limit inflammatory responses due to organ, tissue or cell transplantation, i.e., the transplantation of allogeneic or xenogeneic tissue into a mammalian recipient, autoimmune diseases and inflammatory conditions due to circulatory pathologies and the treatment thereof, including angioplasty, stent placement, shunt placement or grafting. Unexpectedly, it was found that administration of one or more compounds of formula (I) was effective after the onset of the inflammatory response, e.g., after the subject was afflicted with the pathology or trauma that initiates the inflammatory response.

Tissue or cells comprising ligand bound receptor sites can be used to measure the selectively of test compounds for specific receptor subtypes, the amount of bioactive compound in blood or other physiological fluids, or can be used as a tool to identify potential therapeutic agents for the treatment of diseases or conditions associated with receptor site activation, by contacting said agents with said ligand-receptor complexes, and measuring the extent of displacement of the ligand and/or binding of the agent, or the cellular response to said agent (e.g., cAMP accumulation).

Specific and preferred values listed below for radicals, substituents, and ranges, are for illustration only; they do not exclude other defined values or other values within defined ranges for the radicals and substituents.

Specific and preferred values listed below for radicals, substituents, and ranges, are for illustration only; they do not exclude other defined values or other values within defined ranges for the radicals and substituents.

Specifically, (C₁-C₈)alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, sec-butyl, pentyl, 3-pentyl, hexyl, heptyl, octyl and the like. As used herein, the term “(C₁-C₈)alkoxy” can be methoxy, ethoxy, propoxy, isopropoxy, butoxy, iso-butoxy, sec-butoxy, pentoxy, 3-pentoxy, hexyloxy, 1-methylhexyloxy, heptyloxy and the like.

As used herein, the term “cycloalkyl” can be bicycloalkyl (norbornyl, 2.2.2-bicyclooctyl, etc.) and tricycloalkyl (adamantyl, etc.), optionally including 1-2 N, O or S. Cycloalkyl also encompasses (cycloalkyl)alkyl. Thus, (C₃-C₆)cycloalkyl can be cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl and the like. Specifically, (C₆-C₁₂)bicycloalkyl includes norbornyl, 2.2.2-bicyclooctyl and the like.

As used herein, the term “(C₁-C₈)alkoxy” can be methoxy, ethoxy, propoxy, isopropoxy, butoxy, iso-butoxy, sec-butoxy, pentoxy, 3-pentoxy, hexyloxy; and the like.

As used herein, the term “(C₂-C₆)alkenyl” can be vinyl, allyl, 1-propenyl, 2-propenyl, 1-butenyl, 2-butenyl, 3-butenyl, 1-pentenyl, 2-pentenyl, 3-pentenyl, 4-pentenyl, 1-hexenyl, 2-hexenyl, 3-hexenyl, 4-hexenyl, 5-hexenyl, and the like

As used herein, the term “(C₂-C₆)alkynyl” can be ethynyl, 1-propynyl, 2-propynyl, 1-butynyl, 2-butynyl, 3-butynyl, 1-pentynyl, 2-pentynyl, 3-pentynyl, 4-pentynyl, 1-hexynyl, 2-hexynyl, 3-hexynyl, 4-hexynyl, 5-hexynyl, and the like.

As used herein, the term “(C₁-C₈)alkanoyl” can be acetyl, propanoyl, butanoyl, and the like.

As used herein, the term “halo(C₁-C₈)alkyl” can be iodomethyl, bromomethyl, chloromethyl, fluoromethyl, trifluoromethyl, 2-chloroethyl, 2-fluoroethyl, 2,2,2-trifluoroethyl, pentafluoroethyl, and the like.

As used herein, the term “hydroxy(C₁-C₆)alkyl” can be hydroxymethyl, 1-hydroxyethyl, 2-hydroxyethyl, 1-hydroxypropyl, 2-hydroxypropyl, 3-hydroxypropyl, 1-hydroxybutyl, 4-hydroxybutyl, 1-hydroxypentyl, 5-hydroxypentyl, 1-hydroxyhexyl, 6-hydroxyhexyl, and the like.

As used herein, the term “(C₁-C₈)alkylthio” can be methylthio, ethylthio, propylthio, isopropylthio, butylthio, isobutylthio, pentylthio, hexylthio, and the like.

As used herein, the term “aryl includes phenyl, indenyl, indanyl, naphthyl, and the like. In addition, aryl includes ortho-fused bicyclic carbocyclic radicals having about nine to ten ring atoms in which at least one ring is aromatic. The term “aryl” can include radicals of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto.

As used herein, the term “heteroaryl” can be a monocyclic aromatic ring containing five or six ring atoms consisting of carbon and 1, 2, 3, or 4 heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(Y) where Y is absent or is H, O, (C₁-C₈)alkyl, phenyl or benzyl. Non-limiting examples of heteroaryl groups include furyl, imidazolyl, triazolyl, triazinyl, oxazoyl, isoxazoyl, thiazolyl, isothiazoyl, pyrazolyl, pyrrolyl, pyrazinyl, tetrazolyl, pyridyl, (or its N-oxide), thienyl, pyrimidinyl (or its N-oxide), indolyl, isoquinolyl (or its N-oxide), quinolyl (or its N-oxide) and the like. The term “heteroaryl” can include radicals of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto. Examples of heteroaryl can be furyl, imidazolyl, triazolyl, triazinyl, oxazoyl, isoxazoyl, thiazolyl, isothiazoyl, pyraxolyl, pyrrolyl, pyrazinyl, tetrazolyl, pyridyl (or its N-oxide), thientyl, pyrimidinyl (or its N-oxide), indolyl, isoquinolyl (or its N-oxide), quinolyl (or its N-oxide), and the like.

The term “heterocycle” generally represents a non aromatic heterocyclic group, having from 3 to about 10 ring atoms, which can be saturated or partially unsaturated, containing at least one heteroatom (e.g., 1, 2, or 3) selected from the group consisting of oxygen, nitrogen, and sulfur. Specific, “heterocycle” groups include monocyclic, bicyclic, or tricyclic groups containing one or more heteroatoms selected from the group consisting of oxygen, nitrogen, and sulfur. A “heterocycle” group also can include one or more oxo groups (═O) attached to a ring atom. Non-limiting examples of heterocycle groups include 1,3-dioxolane, 1,4-dioxane, 1,4-dithiane, 2H-pyran, 2-pyrazoline, 4H-pyran, chromanyl, imidazolidinyl, imidazolinyl, indolinyl, isochromanyl, isoindolinyl, morpholinyl, piperazinyl, piperidinyl, piperidyl, pyrazolidine, pyrazolidinyl, pyrazolinyl, pyrrolidine, pyrroline, quinuelidine, thiomorpholine, and the like.

The term “(C₁-C₈)alkylene” refers to a divalent straight or branched hydrocarbon chain (e.g. ethylene —CH₂CH₂—).

The term “aryl(C₁-C₈)alkylene” for example includes benzyl, phenethyl, naphthylmethyl and the like.

The carbon atom content of various hydrocarbon-containing moieties is indicated by a prefix designating the minimum and maximum number of carbon atoms in the moiety, i.e., the prefix C_(i)-C_(j) indicates a moiety of the integer “i” to the integer “j” carbon atoms, inclusive. Thus, for example, (C₁-C₈)alkyl refers to alkyl of one to eight carbon atoms, inclusive.

The compounds of the present invention are generally named according to the IUPAC or CAS nomenclature system. Abbreviations which are well known to one of ordinary skill in the art may be used (e.g., “Ph” for phenyl, “Me” for methyl, “Et” for ethyl, “h” for hour or hours and 'rt” for room temperature).

Specific and preferred values listed below for radicals, substituents, and ranges, are for illustration only; they do not exclude other defined values or other values within defined ranges for the radicals and substituents.

A specific value for R¹ is hydrogen, —OH, halo, —CH₂OH, —OMe, —OAc, —NH₂, —NHMe, —NMe₂ or —NHAc.

Another specific value for R¹ is hydrogen,—OH, —F, —OMe, —OAc, —NH₂, —NHMe, —NMe₂ or —NHAc.

Another specific value for R¹ is hydrogen, —OH, —F, —OMe, or —NH₂.

Another specific value for R¹ is hydrogen, —OH, —F, or —NH₂.

A more specific value for R¹ is hydrogen or —OH.

A specific value for R² is hydrogen, (C₁-C₄)alkyl, cyclopropyl, or halo.

Another specific value for R² is hydrogen, methyl, ethyl, propyl, or fluoro.

Another specific value for R² is hydrogen or methyl.

A more specific value for R² is hydrogen.

A specific value for R¹, R² and the carbon atom to which they are attached is carbonyl (C═O).

A specific value for Z is

Another specific value for Z is:

A more specific value for Z is:

A specific value for R⁶ is (C₁-C₈)alkyl, substituted (C₁-C₈)alkyl, halo, —OR^(a), —CO₂R^(a), —OCO₂R^(a), —C(═O)R^(a), —OC(═O)R^(a), NR^(a)R^(b), C(═O)NR^(a)R^(b), —OC(═O)NR^(a)R^(b), or aryl.

Another specific value for R⁶ is (C₁-C₄)alkyl, chloro, fluoro, phenyl, —OR^(a), —CH₂OR^(a), —CO₂R^(a), —CH₂CO₂R^(a), —OCO₂R^(a), —CH₂OCO₂R^(a), —C(═O)R^(a), —CH₂C(═O)R^(a), —OC(═O)R^(a), —CH₂OC(═O)R^(a), —NR^(a)R^(b), —CH₂NR^(a)R^(b), C(═O)NR^(a)R^(b), —CH₂C(═O)NR^(a)R^(b), —OC(═O)NR^(a)R^(b), or —CH₂OC(═O)NR^(a)R^(b).

Another specific value for R⁶ is OH, OMe, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, —CH₂OH, phenyl, —OAc, —CH₂OAc, —CO₂H, —CO₂Me, —CO₂Et, —CO₂i-Pr, —CO₂i-Bu, —CO₂t-Bu, —OCO₂Me, —OCO₂Et, —C(═O)CH₃, —CONH₂, —CONHMe, —CONMe₂, —CONMeEt, —NH₂, —NHMe, —NMe₂, —NHEt, —N(Et)₂, or —CH₂N(CH₃)₂.

Another specific value for R⁶ is OH, OMe, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, —CH₂OH, phenyl, —OAc, —CH₂OAc, —CO₂Me, —CO₂Et, —CO₂i-Pr, —CO₂i-Bu, —CO₂t-Bu, —OCO₂Me, —OCO₂Et, —CONMe₂, —CONMeEt.

A specific number of R⁶ groups substituted on the Z ring is an integer from 1 to about 4.

A specific value for R^(a) is hydrogen, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, phenyl or benzyl.

A specific value for R^(b) is hydrogen, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, phenyl or benzyl.

Another specific value for R^(a) is hydrogen, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, or tert-butyl and R^(b) is hydrogen, or methyl.

Another specific value for R^(a) and R^(b) together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring.

Another specific value for R^(a) and R^(b) together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, or morpholino, ring.

A specific value for R⁷ is hydrogen, (C₁-C₄)alkyl, aryl, aryl(C₁-C₈)alkylene, diaryl(C₁-C₈)alkylene, heteroaryl(C₁-C₈)alkylene, or diheteroaryl(C₁-C₈)alkylene.

Another specific value for R⁷ is hydrogen, methyl, ethyl, 3-pentyl, phenylCH₂CH₂—, (phenyl)₂CHCH₂—, pyridylCH₂—, benzyl, or

Another specific value for R⁷ is hydrogen, 3-pentyl, pyridylmethyl, or benzyl.

A specific value for —N(R⁷)₂ is amino, methylamino, dimethylamino, ethylamino, diethylamino, pentylamino, diphenylethylamino, benzylamino, or

(pyridylmethylamino).

A specific pyridylmethylamino Group is

A more specific value for R⁷is H.

Another specific value for N(R⁷)₂ is amino (NH₂), 3-pentylamino, diphenylethylamino, pyridylmethylamino, benzylamino, or a group having the formula:

Another specific value for —N(R⁷)₂ is amino, diphenylethylamino, pentylamino or benzylamino.

A more specific value for N(R⁷)₂ is amino.

A specific value for X is —CH₂OR^(a) or C(O)NR^(a)R^(b).

A more specific value for X is —CH₂OH or —C(O)NHCH₂CH₃.

A specific value for m is 0, 1, or 2.

A more specific value for m is 0, or 1.

The following abbreviations have been used herein:

-   2-Aas 2-alkynyladenosines; -   ¹²⁵I-ABA N⁶-(4-amino-3-¹²⁵iodo-benzyl)adenosine -   APCI Atmospheric pressure chemical ionization -   ATL146e     4-{3-[6-Amino-9-(5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl)-9H-purin-2-yl]-prop-2-ynyl}cyclo-hexanecarboxylic     acid methyl ester; -   CCPA 2-chloro-N⁶-cyclopentyladenosine; -   CGS21680     2-[4-(2-carboxyethyl)phenethylamino]-5′-N-ethyl-carboxamidoadenosine; -   Cl-IB-MECA N⁶-3-iodo-2-chlorobenzyladenosine-5′-N-methyluronamide; -   CPA N⁶-cyclopentyladenosine -   DMF dimethylformamide -   DMSO dimethylsulfoxide -   DMSO-d₆ deuterated dimethylsulfoxide -   EtOAc ethyl acetate -   eq equivalent -   GPCR G protein coupled receptor; -   hA2AAR Recombinant human A_(2A) adenosine receptor; -   IADO 2-Iodoadenosine -   ¹²⁵I-APE, 2-[2-(4-amino-3-[¹²⁵I]iodophenyl)ethylamino]adenosine;     NECA, 5′-N-ethylcarboxamidoadenosine; -   IB-MECA N⁶-3-iodobenzyladenosine-5′-N-methyluronamide; -   2-Iodoadenosine     5-(6-amino-2-iodo-purin-9-yl)-3,4-dihydroxytetra-hydro-furan-2carboxylic     acid ethylamide -   HPLC high-performance liquid chromatography -   HRMS high-resolution mass spectrometry -   ¹²⁵ I-ZM241385,     ¹²⁵I-4-(2-[7-amino-2-[2-furyl][1,2,4]triazolo[2,3-a][1,3,5]-triazin-5-yl-amino]ethyl)phenol; -   INECA 2-iodo-N-ethylcarboxamidoadenosine -   LC/MS liquid chromatography/mass spectrometry -   m.p. melting point -   MHz megahertz -   MRS 1220,     N-(9-chloro-2-furan-2-yl-[1,2,4]triazolo[1,5-c]-quinazolin-5-yl)-2-phenylacetamide; -   MS mass spectrometry -   NECA N-ethylcarboxamidoadenosine -   NMR nuclear magnetic resonance -   RP-HPLC reverse phase high-performance liquid chromatography -   TBAF tetrabutylammonium fluoride -   TBS tert-butyldimethylsilyl -   TBDMSCl tert-butyldimethylsilylchloride -   TEA triethylamine -   TFA trifluoroacetic acid -   THF tetrahydrofuan -   TLC thin layer chromatography -   p-TSOH para-toluenesulfonic acid -   XAC     8-(4-((2-a-minoethyl)aminocarbonyl-methyloxy)-phenyl)-1-3-dipropylxanthine;

Useful dosages of the compounds of formula I can be determined by comparing their in vitro activity, and in vivo activity in animal models. Methods for the extrapolation of effective dosages in mice, and other animals, to humans are known to the art; for example, see U.S. Pat. No. 4,938,949. Useful dosages of Type IV PDE inhibitors are known to the art. For example, see, U.S. Pat. No. 5,877,180, Col. 12.

Specific Type IV phosphodiesterase (PDE) inhibitors useful in practicing the instant invention include racemic and optically active 4-(polyalkoxyphenyl)-2-pyrrolidones of the following formula:

wherein R′, R¹⁸, R¹⁹ and X are as disclosed and described in U.S. Pat. No. 4,193,926. Rolipram is an example of a suitable Type IV PDE inhibitor included within the above formula.

Additional non-limiting examples of PDE IV inhibitors useful in practicing the instant invention include but are not limited to compounds having the following formulas and variations thereof.

The present invention further provides pharmaceutical compositions that include a compound of Formula (I) in combination with one of more members selected from the group consisting of the following: (a) Leukotriene biosynthesis inhibitors, 5-lipoxygenase (5-LO) inhibitors, and 5-lipoxygenase activating protein (FLAP) antagonists selected from the group consisting of zileuton; ABT-761; fenleuton; tepoxalin; Abbott-79175; Abbott-85761; N-(5-substituted)-thiophene-2-alkylsulfonamides of Formula (5.2.8); 2,6-di-tert-butylphenol hydrazones of Formula (5.2.10); Zeneca ZD-2138 of Formula (5.2.11); SB-210661 of Formula (5.2.12); pyridinyl-substituted 2-cyanonaphthalene compound L-739,010; 2-cyanoquinoline compound L-746,530; indole and quinoline compounds MK-591, MK-886, and BAY×1005; (b) Receptor antagonists for leukotrienes LTB4, LTC4, LTD4, and LTE4 selected from the group consisting of phenothiazin-3-one compound L-651,392; amidino compound CGS-25019c; benzoxazolamine compound ontazolast; benzenecarboximidamide compound BIIL 284/260; compounds zafirlukast, ablukast, montelukast, pranlukast, verlukast (MK-679), RG-12525, Ro-245913, iralukast (CGP 45715A), and BAY×7195; (d) 5-Lipoxygenase (5-LO) inhibitors; and 5-lipoxygenase activating protein (FLAP) antagonists; (e) Dual inhibitors of 5-lipoxygenase (5-LO) and antagonists of platelet activating factor (PAF); (f) Theophylline and aminophylline; (g) COX-1 inhibitors (NSAIDs); and nitric oxide NSAIDs; (h) COX-2 selective inhibitor rofecoxib; (i) Inhaled glucocorticoids with reduced systemic side effects selected from the group consisting of prednisone, prednisolone, flunisolide, triamcinolone acetonide, beclomethasone dipropionate, budesonide, fluticasone propionate, and mometasone furoate; (j) Platelet activating factor (PAF) antagonists; (k) Monoclonal antibodies active against endogenous inflammatory entities; (l) Anti-tumor necrosis factor (TNFα) agents selected from the group consisting of etanercept, infliximab, and D2E7; (m) Adhesion molecule inhibitors including VLA-4 antagonists; (n) Immunosuppressive agents selected from the group consisting of cyclosporine, azathioprine, and methotrexate; or (o) anti-gout agents selected from the group consisting of colchicines.

Compounds of the invention can generally be prepared as illustrated in Schemes 1A and 1B below. Starting materials can be prepared by procedures described in these schemes, procedures described in the General methods below or by procedures that would be well known to one of ordinary skill in organic chemistry. The variables used in Schemes 1A and Scheme 1B are as defined herein or as in the claims.

The preparation of alkynyl cycloalkanols is illustrated in Scheme 1A. A solution of an appropriate polycyclic ketone (where n is from 0-5) is prepared in a solvent such as THF. A solution of a suitable ethynylmagnesium halide compound in a solvent is added to the cycloalkanone. After addition, the solution is allowed to stir at about 20° C. for about 20 hours. The reaction is monitored via TLC until the starting material is consumed. The reaction is quenched with water, filtered over a plug of sand and silica, washed with a solvent, such as EtOAc, and evaporated to provide the product. Typically, two products are formed, the isomers formed by the axial/equatorial addition of the alkyne (where m is as defined above, and the sum of m1 and m2 is from 0 to about 7) to the ketone. The compounds are purified via flash chromatography using EtOAc/Hexanes to provide the product.

Non-limiting examples of polycyclic compounds useful in practicing the instant invention have the formulas shown below.

The preparation of the 2-alkynyladenosines of the invention is illustrated in Scheme 1B. A flame-dried round bottom flask under nitrogen is charged with a 2-Iodo adenosine analog (˜40 mg) and dissolved in a solvent such as DMF. The appropriate alkyne (approx 0.1 mL) is then added followed by 4 mL of acetonitrile and 0.1 mL of TEA. All three solvents are degassed with nitrogen for at least 24 hours. Pd(PPh₃)₄ (5 mole %) and copper iodide (6 mole %) are added to this solution and the mixture is allowed to stir for about 24 hours under nitrogen at room temperature, or until complete as determined by HPLC. If the reaction is not complete at this time, additional catalyst, CuI, and TEA are added. After the reaction is complete, the solvents are removed under high-vacuum and the residue taken back up in a small amount of DMF. This solution is added to a preparative silica TLC plate (Analtech 1000 microns, 20 cm×20 cm) and eluted first with 120 mL of 40% Hexanes/CH₂Cl₂, and then again after addition of 40 mL of MeOH. The UV active band (usually yellow in color) in the middle of the plate is collected, slowly washed with 4×25 mL 20% MeOH/CH₂Cl₂, and concentrated. This product is then purified by RP-HPLC to yield solids after trituration with anhydrous ethyl ether.

Examples of pharmaceutically acceptable salts are organic acid addition salts formed with acids which form a physiological acceptable anion, for example, tosylate, methanesulfonate, malate, acetate, citrate, malonate, tartarate, succinate, benzoate, ascorbate, α-ketoglutarate, and α-glycerophosphate. Suitable inorganic salts may also be formed, including hydrochloride, sulfate, nitrate, bicarbonate, and carbonate salts.

Pharmaceutically acceptable salts may be obtained using standard procedures well known in the art, for example by reacting a sufficiently basic compound such as an amine with a suitable acid affording a physiologically acceptable anion. Alkali metal (for example, sodium, potassium or lithium) or alkaline earth metal (for example calcium) salts of carboxylic acids can also be made.

The compounds of formula I can be formulated as pharmaceutical compositions and administered to a mammalian host, such as a human patient in a variety of forms adapted to the chosen route of administration, i.e., orally or parenterally, by intravenous, intramuscular, topical, ocular, aerosol, nasal, as a sepository or via subcutaneous routes.

Thus, the present compounds may be systemically administered, e.g., orally, in combination with a pharmaceutically acceptable vehicle such as an inert diluent or an assimilable edible carrier. They may be enclosed in hard or soft shell gelatin capsules, may be compressed into tablets, or may be incorporated directly with the food of the patient's diet. For oral therapeutic administration, the active compound may be combined with one or more excipients and used in the form of ingestible tablets, buccal tablets, troches, capsules, elixirs, suspensions, syrups, wafers, and the like. Such compositions and preparations should contain at least 0.1% of active compound. The percentage of the compositions and preparations may, of course, be varied and may conveniently be between about 2 to about 60% of the weight of a given unit dosage form. The amount of active compound in such therapeutically useful compositions is such that an effective dosage level will be obtained.

The tablets, troches, pills, capsules, and the like may also contain the following: binders such as gum tragacanth, acacia, corn starch or gelatin; excipients such as dicalcium phosphate; a disintegrating agent such as corn starch, potato starch, alginic acid and the like; a lubricant such as magnesium stearate; and a sweetening agent such as sucrose, fructose, lactose or aspartame or a flavoring agent such as peppermint, oil of wintergreen, or cherry flavoring may be added. When the unit dosage form is a capsule, it may contain, in addition to materials of the above type, a liquid carrier, such as a vegetable oil or a polyethylene glycol. Various other materials may be present as coatings or to otherwise modify the physical form of the solid unit dosage form. For instance, tablets, pills, or capsules may be coated with gelatin, wax, shellac or sugar and the like. A syrup or elixir may contain the active compound, sucrose or fructose as a sweetening agent, methyl and propylparabens as preservatives, a dye and flavoring such as cherry or orange flavor. Of course, any material used in preparing any unit dosage form should be pharmaceutically acceptable and substantially non-toxic in the amounts employed. In addition, the active compound may be incorporated into sustained-release preparations and devices.

The active compound may also be administered intravenously or intraperitoneally by infusion or injection. Solutions of the active compound or its salts can be prepared in water, optionally mixed with a nontoxic surfactant. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, triacetin, and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.

The pharmaceutical dosage forms suitable for injection or infusion can include sterile aqueous solutions or dispersions or sterile powders comprising the active ingredient which are adapted for the extemporaneous preparation of sterile injectable or infusible solutions or dispersions, optionally encapsulated in liposomes. In all cases, the ultimate dosage form must be sterile, fluid and stable under the conditions of manufacture and storage. The liquid carrier or vehicle can be a solvent or liquid dispersion medium comprising, for example, water, ethanol, a polyol (for example, glycerol, propylene glycol, liquid polyethylene glycols, and the like), vegetable oils, nontoxic glyceryl esters, and suitable mixtures thereof. The proper fluidity can be maintained, for example, by the formation of liposomes, by the maintenance of the required particle size in the case of dispersions or by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars, buffers or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions are prepared by incorporating the active compound in the required amount in the appropriate solvent with various of the other ingredients enumerated above, as required, followed by filter sterilization. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and the freeze drying techniques, which yield a powder of the active ingredient plus any additional desired ingredient present in the previously sterile-filtered solutions.

For topical administration, the present compounds may be applied in pure form, i.e., when they are liquids. However, it will generally be desirable to administer them to the skin as compositions or formulations, in combination with a dermatologically acceptable carrier, which may be a solid, a liquid or in a dermatological patch.

Useful solid carriers include finely divided solids such as talc, clay, microcrystalline cellulose, silica, alumina and the like. Useful liquid carriers include water, alcohols or glycols or water-alcohol/glycol blends, in which the present compounds can be dissolved or dispersed at effective levels, optionally with the aid of non-toxic surfactants. Adjuvants such as fragrances and additional antimicrobial agents can be added to optimize the properties for a given use. The resultant liquid compositions can be applied from absorbent pads, used to impregnate bandages and other dressings, or sprayed onto the affected area using pump-type or aerosol sprayers.

Thickeners such as synthetic polymers, fatty acids, fatty acid salts and esters, fatty alcohols, modified celluloses or modified mineral materials can also be employed with liquid carriers to form spreadable pastes, gels, ointments, soaps, and the like, for application directly to the skin of the user.

Examples of useful dermatological compositions, which can be used to deliver the compounds of formula I to the skin are disclosed in Jacquet et al. (U.S. Pat. No. 4,608,392), Geria (U.S. Pat. No. 4,992,478), Smith et al. (U.S. Pat. No. 4,559,157) and Wortzman (U.S. Pat. No. 4,820,508).

Generally, the concentration of the compound(s) of formula (I) in a liquid composition, such as a lotion, will be from about 0.1-25% wt-%, preferably from about 0.5-10 wt-%. The concentration in a semi-solid or solid composition such as a gel or a powder will be about 0.1-5 wt-%, preferably about 0.5-2.5 wt-%.

The amount of the compound, or an active salt or derivative thereof, required for use in treatment will vary not only with the particular salt selected but also with the route of administration, the nature of the condition being treated and the age and condition of the patient and will be ultimately at the discretion of the attendant physician or clinician.

In general, however, a suitable dose will be in the range of from about 0.5 to about 100 μg/kg, e.g., from about 10 to about 75 μg/kg of body weight per day, such as 3 to about 50 μg per kilogram body weight of the recipient per day, preferably in the range of 6 to 90 μg/kg/day, most preferably in the range of 15 to 60 μg/kg/day.

The compound is conveniently administered in unit dosage form; for example, containing 5 to 1000 μg, conveniently 10 to 750 μg, most conveniently, 50 to 500 μg of active ingredient per unit dosage form.

Ideally, the active ingredient should be administered to achieve peak plasma concentrations of the active compound of from about 0.1 to about 10 nM, preferably, about 0.2 to 10 nM, most preferably, about 0.5 to about 5 nM. This may be achieved, for example, by the intravenous injection of a 0.05 to 5% solution of the active ingredient, optionally in saline, or orally administered as a bolus containing about 1-100 μg of the active ingredient. Desirable blood levels may be maintained by continuous infusion to provide about 0.01-5.0 μg/kg/hr or by intermittent infusions containing about 0.4-15 μg/kg of the active ingredient(s).

The desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as two, three, four or more sub-doses per day. The sub-dose itself may be further divided, e.g., into a number of discrete loosely spaced administrations; such as multiple inhalations from an insufflator or by application of a plurality of drops into the eye. For example, it is desirable to administer the present compositions intravenously over an extended period of time following the insult that gives rise to inflammation.

The ability of a given compound of the invention to act as an A_(2A) adenosine receptor agonist may be determined using pharmacological models which are well known to the art, or using tests described below.

The present compounds and compositions containing them are administered as pharmacological stressors and used in conjunction with any one of several noninvasive diagnostic procedures to measure aspects of myocardial perfusion. For example, intravenous adenosine may be used in conjunction with thallium-201 myocardial perfusion imaging to assess the severity of myocardial ischemia. In this case, any one of several different radiopharmaceuticals may be substituted for thallium-201 (e.g., technetium-99m-labeled radiopharmaceuticals (ie: Tc-99m-sestamibi, Tc-99m-teboroxime), iodine-123-labeled radiopharmaceuticals such as I-1 23-IPPA or BMIPP, rubidium-82, nitrogen-13, etc . . . ). Similarly, one of the present compounds may be administered as a pharmacological stressor in conjunction with radionuclide ventriculography to assess the severity of myocardial contractile dysfunction. In this case, radionuclide ventriculographic studies may be first pass or gated equilibrium studies of the right and/or left ventricle. Similarly, a compound of formula (I) may be administered as a pharmacological stressor in conjunction with echocardiography to assess the presence of regional wall motion abnormalities. Similarly, the active compound may be administered as a pharmacological stressor in conjunction with invasive measurements of coronary blood flow such as by intracardiac catheter to assess the functional significance of stenotic coronary vessels.

The method typically involves the administration of one or more compounds of formula (I) by intravenous infusion in doses which are effective to provide coronary artery dilation (approximately 0.25-500, preferably 1-250 mcg/kg/min). However, its use in the invasive setting may involve the intracoronary administration of the drug in bolus doses of 0.5-50 mcg.

Preferred methods comprise the use of a compound of formula (I) as a substitute for exercise in conjunction with myocardial perfusion imaging to detect the presence and/or assess the severity of coronary artery disease in humans wherein myocardial perfusion imaging is performed by any one of several techniques including radiopharmaceutical myocardial perfusion imaging using planar scintigraphy or single photon emission computed tomography (SPECT), positron emission tomograph (PET), nuclear magnetic resonance (NMR) imaging, perfusion contrast echocardiography, digital subtraction angiography (DSA), or ultrafast X-ray computed tomography (CINE CT).

A method is also provided comprising the use of a compound of formula (I) as a substitute for exercise in conjunction with imaging to detect the presence and/or assess the severity of ischemic ventricular dysfunction in humans wherein ischemic ventricular dysfunction is measured by any one of several imaging techniques including echocardiography, contrast ventriculography, or radionuclide ventriculography. The myocardial dysfunction can be coronary artery disease, ventricular dysfunction, differences in blood flow through disease-free coronary vessels and stenotic coronary vessels and the like

A method is also provided comprising the use of a compound of formula (I) as a coronary hyperemic agent in conjunction with means for measuring coronary blood flow velocity to assess the vasodilatory capacity (reserve capacity) of coronary arteries in humans wherein coronary blood flow velocity is measured by any one of several techniques including Doppler flow catheter or digital subtraction angiography.

The invention will be further described by reference to the following detailed examples, which are given for illustration of the invention, and are not intended to be limiting thereof.

DESCRIPTION OF PREFERRED EMBODIMENTS

All melting points were determined with a Thomas Hoover capillary melting point apparatus and are uncorrected. Nuclear magnetic resonance spectra for proton (¹H NMR) were recorded on a 300 MHz GE spectrophotometer. The chemical shift values are expressed in ppm (parts per million) relative to tetramethylsilane. For data reporting, s=singlet, d=doublet, t=triplet, q=quartet, and m=multiplet. Mass spectra were measured on a Finnigan LcQ Classic. High resolution mass spectrometry (HRMS) data was provided by the Nebraska Center for Mass Spectrometry. Analytical HPLC was done on a Waters 2690 Separation Module with a Waters Symmetry C8 (2.1×150 mm) column operated at room temperature. Compounds were eluted at 200 μL/min with 70:30 acetonitrile:water, containing 0.5% acetic acid, with UV detection at 214 nm using a Waters 486 Tunable Detector. Preparative HPLC was performed on a Shimadzu Discovery HPLC with a Shim-pack VP-ODS C₁₈ (20×100 mm) column operated at room temperature. Compounds were eluted at 30 mL/min with a gradient 20-80% of water (containing 0.1% TFA) to methanol over 15 minutes with UV detection at 214 nm using a SPD10A VP Tunable detector. All final compounds presented here were determined to be greater than 98% pure by HPLC. Flash chromatography was performed on Silicyle 60A gel (230-400 mesh) or using reusable chromatography columns and system from RT Scientific, Manchester N.H. Analytical thin-layer chromatography was done on Merck Kieselgel 60 F254 aluminum sheets. Preparative thin-layer chromatography was done using 1000 micron Analtech Uniplate with silica gel. All reactions were done under a nitrogen atmosphere in flame-dried glassware unless otherwise stated.

General Method 1: Preparation of Alkynyl Compounds

To a solution of 10 mmol of the appropriate ketone in 50 mL of THF was added 60 mL (30 mmol) of 0.5 M ethynylmagnesium bromide in THF. The solution was allowed to stir at 20° C. for 20 h, at which time TLC indicated that all the starting material had been consumed. The reaction was quenched with 5 mL of water, filtered over a plug of sand and silica, washed with EtOAc, and evaporated to yield a yellow oil usually containing two spots on TLC w/20% EtOAc/Hexanes which were visualized with Vanillin. These two products were usually the different isomers formed by the axial/equatorial addition of the alkyne to the ketone. The compounds were purified via flash chromatography using 10% EtOAc/Hexanes to yield clear oils or white solids in 50-80% yields. Following the general and specific descriptions herein the compounds of the invention were prepared.

General method 2: Palladium Catalyzed Coupling

A flame-dried round bottom flask under nitrogen is charged with a 2-Iodo adenosine analog (˜40 mg) and dissolved in a solvent such as DMF. The appropriate alkyne (approx 0.1 mL) is then added followed by 4 mL of acetonitrile and 0.1 mL of TEA. All three solvents are degassed with nitrogen for at least 24 hours. Pd(PPh₃)₄ (5 mole %) and copper iodide (6 mole %) are added to this solution and the mixture is allowed to stir for about 24 hours under nitrogen at room temperature, or until complete as determined by HPLC. If the reaction is not complete at this time, additional catalyst, CuI, and TEA are added. After the reaction is complete, the solvents are removed under high-vacuum and the residue taken back up in a small amount of DMF. This solution is added to a preparative silica TLC plate (Analtech 1000 microns, 20 cm 20 cm) and eluted first with 120 mL of 40% Hexanes/CH₂Cl₂, and then again after addition of 40 mL of MeOH. The UV active band (usually yellow in color) in the middle of the plate is collected, slowly washed with 4×25 mL 20% MeOH/CH₂Cl₂, and concentrated. This product is then purified by RP-HPLC to yield solids after trituration with anhydrous ethyl ether.

EXAMPLES 1 AND 2 5-[6-Amino-2-(2-hydroxy-bicyclo[2.2.1]hept-2-ylethynyl)-purin-9-yl]-3,4-dihydroxy-tetrahydro-furan-2-carboxylic acid ethylamide.

Two isomers were isolated after palladium catalyzed coupling and separated by preparative RP HPLC (48% MeOH/H₂O isochratic)using a Varian Dynamax 5 μm HPLC column 250×21.4 mm at a flow of 15 mL/min. The two isomers had retention times of 23.9 and 26.5 min respectively and are believed to be the two isomers shown above.

-   Cmpd 1: MS: m/z 443 (M+H)⁺. -   Cmpd 2: MS: m/z 443 (M+H)⁺.

EXAMPLE 3 5-[6-Amino-2-(2-hydroxy-adamantan-2-ylethynyl)-purin-9-yl]-3,4-dihydroxy-tetrahydro-furan-2-carboxylic acid ethylamide.

MS: m/z 483 (M+H)⁺.

EXAMPLE 4 5-[6-Amino-2-(1-hydroxy-decahydro-naphthalen-1-ylethynyl)-purin-9-yl]-3,4-dihydroxy-tetrahydro-furan-2-carboxylic acid ethylamide.

MS: m/z 485 (M+H)⁺.

EXAMPLE 5 5-[6-Amino-2-(1-hydroxy-decahydro-naphthalen-1-ylethynyl)-purin-9-yl]-3,4-dihydroxy-tetrahydro-furan-2-carboxylic acid ethylamide.

MS: m/z 485 (M+H)⁺.

EXAMPLE 6 2-[6-Amino-2-(2-hydroxy-adamantan-2-ylethynyl)-purin-9-yl]-5-hydroxymethyl-tetrahydro-furan-3,4-diol.

MS: m/z 442 (M+H)⁺.

EXAMPLE 7 Cell Culture and Membrane Preparation

Sf9 cells were cultured in Grace's medium supplemented with 10% fetal bovine serum, 2.5 μg/ml amphotericin B and 50 μg/ml gentamycin in an atmosphere of 50% N₂/50% O₂. Viral infection was performed at a density of 2.5×10⁶ cells/mL with a multiplicity of infection of two for each virus used. Infected cells were harvested 3 days post-infection and washed twice in insect PBS (PBS pH 6.3). Cells were then resuspended in lysis buffer (20 mM HEPES pH 7.5, 150 mM NaCl, 3 mM MgCl₂, 1 mM β-mercaptoethanol (BME), 5 μg/mL leupeptin, 5 μg/mL pepstatin A, 1 μg/mL aprotinin, and 0.1 mM PMSF) and snap frozen for storage at −80° C. Cells were thawed on ice, brought to 30 mL total volume in lysis buffer, and burst by N₂ cavitation (600 psi for 20 minutes). A low-speed centrifugation was performed to remove any unlysed cells (1000×g for 10 minutes), followed by a high-speed centrifugation (17,000×g for 30 minutes). The pellet from the final centrifugation was homogenized in buffer containing 20 mM HEPES pH 8, 100 mM NaCl, 1% glycerol, 2 μg/mL leupeptin, 2 μg/mL pepstatin A, 2 μg/mL Aprotinin, 0.1 mM PMSF, and 10 μM GDP using a small glass homogenizer followed by passage through a 26 gauge needle. Membranes were aliquoted, snap frozen in liquid N₂, and stored at −80° C. Membranes from cells stably expressing the human A₁ AR (CHO K1 cells) or A₃ AR (HEK 293 cells) were prepared as described (Robeva et al., 1996).

EXAMPLE 8 Radioligand Binding Assays

Radioligand binding to recombinant human A_(2A) receptors in Sf9 cell membranes was performed using either the radio labeled agonist, ¹²⁵I-APE (Luthin et al., 1995) or the radio labeled antagonist, ¹²⁵I-ZM241385 (¹²⁵1-ZM). To detect the high affinity, GTPγS-sensitive state of A₁ and A₃ AR, we used the agonist, ¹²⁵I-ABA (Linden et al., 1985;Linden et al., 1993). Binding experiments were performed in triplicate with 5 μg (A_(2A)) or 25 μg (A₁ and A₃) membrane protein in a total volume of 0.1 mL HE buffer (20 mM HEPES and 1 mM EDTA) with 1 U/mL adenosine deaminase and 5 mM MgCl₂ with or without 50 μM GTPγS. Membranes were incubated with radioligands at room temperature for three hours (for agonists) or two hours (for antagonists) in Millipore Multiscreen® 96-well GF/C filter plates and assays were terminated by rapid filtration on a cell harvester (Brandel, Gaithersburg, Md.) followed by 4×150 μl washes over 30 seconds with ice cold 10 mM Tris-HCl, pH 7.4, 10 mM MgCl₂. Nonspecific binding was measured in the presence of 50 μM NECA. Competition binding assays were performed as described (Robeva et al., 1996) using 0.5-1 nM ¹²⁵I-APE, ¹²⁵I-ZM241385, or ¹²⁵I-ABA. We found that it was sometimes important to change pipette tips following each serial dilution to prevent transfer on tips of potent hydrophobic compounds. The K_(i) values for competing compound binding to a single site were derived from IC₅₀ values with correction for radioligand and competing compound depletion as described previously (Linden, 1982).

Linden J (1982) Calculating the Dissociation Constant of an Unlabeled Compound From the Concentration Required to Displace Radiolabel Binding by 50%. J Cycl Nucl Res 8: 163-172.

Linden J, Patel A and Sadek S (1985) [¹²⁵I]Aminobenzyladenosine, a New Radioligand With Improved Specific Binding to Adenosine Receptors in Heart. Circ Res 56: 279-284.

Linden J, Taylor H E, Robeva A S, Tucker A L, Stehle J H, Rivkees S A, Fink J S and Reppert S M (1993) Molecular Cloning and Functional Expression of a Sheep A₃ Adenosine Receptor With Widespread Tissue Distribution. Mol Pharmacol 44: 524-532.

Luthin D R, Olsson R A, Thompson R D, Sawmiller D R and Linden J (1995) Characterization of Two Affinity States of Adenosine A_(2A) Receptors With a New Radioligand, 2-[2-(4-Amino-3-[¹²⁵I]Iodophenyl)Ethylamino]Adenosine. Mol Pharmacol 47: 307-313.

Robeva A S, Woodard R, Luthin D R, Taylor H E and Linden J (1996) Double Tagging Recombinant A₁- and A_(2A)-Adenosine Receptors With Hexahistidine and the FLAG Epitope. Development of an Efficient Generic Protein Purification Procedure. Biochem Pharmacol 51: 545-555.

Chemiluminescence Methods: Luminol enhanced chemiluminescence, a measure of neutrophil oxidative activity, is dependent upon both superoxide production and mobilization of the granule enzyme myeloperoxidase. The light is emitted from unstable high-energy oxygen species such as hypochlorous acid and singlet oxygen generated by activated neutrophils.

Purified human neutrophils (2×106/ml) suspended in Hanks balanced salt solution containing 0.1% human serum albumin (HA), adenosine deaminase (1 U/mL) and rolipram (100 nM) were incubated (37° C.) in a water bath for 15 min with or without rhTNF(10 U/ml). Following incubation 100 L aliquots of the PMN were transferred to wells (White walled clear bottom 96 well tissue culture plates Costar #3670; 2 wells/condition) containing 501 HA and luminol (final concentration 100M) with or without adenosine agonist (final agonist concentrations 0.01-1000 nM). The plate was incubated 5 min (37° C.) and then FMLP (501 in HA; final concentration 1M) was added to all wells.

Peak chemiluminescence was determined with a Victor 1420 Multilabel Counter in the chemiluminescence mode using the Wallace Workstation software. Data are presented as peak chemiluminescence as percent of activity in the absence of an adenosine agonist. The EC₅₀ was determined using PRISM software. All compounds were tested with PMNs from three separate donors. The results are summarized in Table 1. TABLE 1 Binding Affinity, Selectivity, and Functional Activity for A_(2A) Agonists Functional Functional + Compound A₁ (nM) A_(2A) (nM) A₃ (nM) (nM)¹ Roli (nM)² Example 1 31 0.2 10 3.1 0.22 Example 2 11 0.3 3 0.5 0.058 Example 3 75 0.2 4 3.8 0.22 Example 4 7.3 6.4 28.3 25 3.7 Example 5 2.6 0.7 4.9 2.5 0.28 Example 6 28.5 0.6 2.9 4.9 0.3 ¹Human neutrophil experiment as described in Example 9 without Rolipram. ²Human neutrophil experiment as described in Example 9 with Rolipram.

EXAMPLE 9 Effect of A_(2A) Agonists on Neutrophil Oxidative Activity

A. Materials.

f-met-leu-phe (fMLP), luminol, superoxide dismutase, cytochrome C, fibrinogen, adenosine deaminase, and trypan blue were obtained from Sigma Chemical. Ficoll-hypaque was purchased from ICN (Aurora, Ohio), and Cardinal Scientific (Santa Fe, N.M.) and Accurate Chemicals and Scientific (Westerbury, N.Y.). Endotoxin (lipopolysaccharide; E. coli K235) was from List Biologicals (Campbell, Calif.). Hanks balanced salt solution (HBSS), and limulus amebocyte lysate assay kit were from BioWittaker (Walkersville, Md.). Human serum albumin (HSA) was from Cutter Biological (Elkhart, Ind.). Recombinant human tumor necrosis factor-alpha was supplied by Dianippon Pharmaceutical Co. Ltd. (Osaka, Japan). ZM241385 (4-(2-[7-amino-2-(2-furyl)[1,2,4]triazolo[2,3-a][1,3,5]triazin-5-yl amino]ethyl)phenol) was a gift from Simon Poucher, Zeneca Pharmaceuticals, Cheshire, UK. Stock solutions (1 mM and 10 mM in DMSO) were made and stored at −20° C.

B. Human Neutrophil Preparation

Purified neutrophils (˜98% neutrophils and >95% viable by trypan blue exclusion) containing <1 platelet per 5 neutrophils and <50 pg/ml endotoxin (limulus amebocyte lysate assay) were obtained from normal heparinized (10 U/ml) venous blood by a one step Ficoll-hypaque separation procedure (A. Ferrante et al., J. Immunol. Meth., 36, 109 (1980)).

C. Release of Inflammatory Reactive Oxygen Species from Primed and Stimulated Human Neutrophils Chemiluminescence

Luminol-enhanced chemiluminescence, a measure of neutrophil oxidative activity, is dependent upon both superoxide production and mobilization of the lysosomal granule enzyme myeloperoxidase. The light is emitted from unstable high-energy oxygen species generated by activated neutrophils. Purified neutrophils (5-10×10⁵/ml) were incubated in Hanks balanced salt solution containing 0.1% human serum albumin (1 ml) with the tested A_(2A) agonist with or without rolipram and with or without tumor necrosis factor-alpha (1 U/ml) for 30 minutes at 37° C. in a shaking water bath. Then luminol (1×10⁻⁴ M) enhanced f-met-leu-phe (1 mcM) stimulated chemiluminescence was read with a Chronolog® Photometer (Crono-log Corp., Havertown, Pa.) at 37° C. for 2-4 minutes. Chemiluminescence is reported as relative peak light emitted (=height of the curve) compared to samples with tumor necrosis factor-alpha and without agonist or rolipram.

EXAMPLE 10 In Vivo Rat Blood Pressure Experiments

Sprague-Dawley rats (mean weights, 250-300 grams) were anthesthetized and jugular and carotid catheters are implanted ipsilaterally and the animals are allowed to recover 24-48 hours. Prior to each experiment a baseline blood pressure reading is established for 30 minutes with each drug injection being preceded by a vehicle control. Drugs are injected bolus I.V. through a jugular catheter in a 200 microliter volume of saline and the catheter is flushed with an additional 300 microliters of saline. To measure blood pressure, a central line from the carotid catheter is attached to the pressure transducer of a Digi-Med Blood Pressure Analyzer. Systolic pressure, diastolic pressure, mean pressure, and heart rate are all recorded in real time at 30-60 second intervals. Data is recorded until mean blood pressure has returned to baseline and remained constant for 20 minutes. The data is presented as a fraction of the mean blood pressure averaged over the 10 minutes immediately prior to drug injection. The blood pressures are recorded and plotted over time as a means of determining potency of the compounds as well as biological half-life.

The compound of example 2 was tested against a control compound, illustrated below:

The results are illustrated in FIG. 1.

All publications, patents, and patent documents are incorporated by reference herein, as though individually incorporated by reference. The invention has been described with reference to various specific and preferred embodiments and techniques. However, it should be understood that many variations and modifications may be made while remaining within the spirit and scope of the invention. 

1. A compound having formula (I):

wherein each R¹ is independently hydrogen, halo, —OR^(a), —SR^(a), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₃-C₈)cycloalkyl, heterocycle, heterocyclic(C₁-C₈)alkylene-, aryl, aryl(C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, —CO₂R^(a), R^(a)C(═O)O—, R^(a)C(═O)—, —OCO₂R^(a), R^(a)R^(b)NC(═O)O—, R^(b)OC(═O)N(R^(a))—, R^(a)R^(b)N—, R^(a)R^(b)NC(═O)—, R^(a)C(═O)N(R^(b))—, R^(a)R^(b)NC(═O)N(R^(b))—, R^(a)R^(b)NC(═S)N(R^(b))—, —OPO₃R^(a), R^(a)OC(═S)—, R^(a)C(═S)—, —SSR^(a), R^(a)S(═O)—, R^(a)S(═O)₂—, —N═NR^(a), or —OPO₂R^(a); each R² is independently hydrogen, halo, (C₁-C₈)alkyl, (C₃-C₈)cycloalkyl, heterocycle, heterocycle(C₁-C₈)alkylene-, aryl, aryl(C₁-C₈)alkylene-, heteroaryl, or heteroaryl(C₁-C₈)alkylene-; or R¹ and R² and the atom to which they are attached is C═O, C═S or C═NR^(c); Z is

wherein each Z group is optionally substituted with from 1 to 10 R⁶ groups; each R⁶ is independently halo, —OR^(a), —SR^(a), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₁-C₈)cycloalkyl, (C₆-C₁₂)bicycloalkyl, heterocycle or heterocyclic(C₁-C₈)alkylene-, aryl, aryl (C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, -CO₂R^(a), R^(a)C(═O)O—, R^(a)C(═O)—, —OCO₂R^(a), R^(a)R^(b)NC(═O)O—, R^(b)OC(═O)N(R^(a))—, R^(a)R^(b)N—, R^(a)R^(b)NC(═O)—, R^(a)C(═O)N(R^(b))—, R^(a)R^(b)NC(═O)N(R^(b))—, R^(a)R^(b)NC(═S)N(R^(b))—, —OPO₃R^(a), R^(a)OC(═S)—, R^(a)C(═S)—, —SSR^(a), R^(a)S(═O)—, —NNR^(a), —OPO₂R^(a), or two R⁶ groups and the atom to which they are attached is C═O, C═S; or two R⁶ groups together with the atom or atoms to which they are attached can form a carbocyclic or a heterocyclic ring comprising from 1 to 6 carbon atoms and 1, 2, 3, or 4 heteroatoms selected from non-peroxide oxy (—O—), thio (—S—), sulfinyl (—S—-), sulfonyl (—S(O)₂—), phosphine (—OP(O)₂—, or amine (—NR^(a)—) in the ring; each R⁷ is independently hydrogen, (C₁-C₈)alkyl, (C₃-C₈)cycloalkyl, aryl or aryl(C₁-C₈)alkylene, heteroaryl, heteroaryl(C₁-C₈)alkylene-; X is —CH₂OR^(a), —CO₂R^(a), —CH₂OC(O)R^(a), —C(O)NR^(a)R^(b), —CH₂SR^(a), —C(S)OR^(a), —CH₂OC(S)R^(a) or C(S)NR^(a)R^(b) or —CH₂N(R^(a))(R^(b)); wherein any of the alkyl, cycloalkyl, heterocycle, aryl, or heteroaryl, groups of R¹, R², R⁶ and R⁷ is optionally substituted on carbon with one or more (e.g. 1, 2, 3, or 4) substituents selected from the group consisting of halo, —OR^(f), —SR^(f), (C₁-C₈)alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C₃-C₈)cycloalkyl, (C₆-C₁₂)bicycloalkyl, heterocycle or heterocyclic(C₁-C₈)alkylene-, aryl, aryloxy, aryl (C₁-C₈)alkylene-, heteroaryl, heteroaryl(C₁-C₈)alkylene-, —CO₂R^(f), R^(f)C(═O)O—, R^(f)C(═O)—, —OCO₂R^(f), R^(f)R^(g)NC(═O)O—, R^(g)OC(═O)N(R^(f))—, R^(f)R^(g)N—, R^(f)R^(g)NC(═O)—, R^(f)C(═O)N(R^(g))—, R^(f)R^(g)NC(═O)N(R^(g))—, R^(f)R^(g)NC(═S)N(R^(g))—, —OPO₃R^(f), R^(f)OC(═S)—, R^(f)C(═S)—, —SSR^(f), R^(f)S(═O)_(p)—, R^(f)R^(g)NS(O)_(p)—, N═NR^(f), and —OPO₂R^(f); wherein any (C₁-C₈)alkyl, (C₃-C₈)cycloalkyl, (C₆-C₁₂)bicycloalkyl, (C₁-C₈)alkoxy, (C₁-C₈)alkanoyl, (C₁-C₈)alkylene, or heterocycle, is optionally partially unsaturated; R^(a) and R^(b) are each independently hydrogen, (C₁-C₈)alkyl, or (C₁-C₈)alkyl substituted with 1-3 (C₁-C₈)alkoxy, (C₃-C₈)cycloalkyl, (C₁-C₈)alkylthio, aryl, aryl(C₁-C₈)alkylene, heteroaryl, or heteroaryl(C₁-C₈)alkylene; or R^(a) and R^(b), together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring; R^(f) and R^(g) are each independently hydrogen, (C₁-C₈)alkyl, or (C₁-C₈)alkyl substituted with 1-3 (C₁-C₈)alkoxy, (C₃-C₈)cycloalkyl, (C₁-C₈)alkylthio; aryl, aryl(C₁-C₈)alkylene, heteroaryl, or heteroaryl(C₁-C₈)alkylene; or R^(f) and R^(g), together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring; and R^(c) is hydrogen or (C₁-C₆)alkyl; m is 0, 1, 2, 3, 4, 5, 6, 7, or 8 and p is 1,or 2; or a pharmaceutically acceptable salt thereof.
 2. The compound of claim 1, wherein R¹ is hydrogen, halo, —OH, —CH₂OH, —OMe, —OAc, —NH₂, —NHMe, —NMe₂ or —NHAc.
 3. The compound of claim 1, wherein R¹ is hydrogen, OH, OMe, fluoro, or NH₂.
 4. The compound of claim 3, wherein R¹ is hydrogen, OH, fluoro, or NH₂.
 5. The compound any of claim 4, wherein R¹ is hydrogen or OH.
 6. The compound any of claim 1, wherein R² is hydrogen, (C₁-C₄)alkyl, cyclopropyl, or halo.
 7. The compound of claim 6, wherein R² is hydrogen, methyl, ethyl, propyl, or fluoro.
 8. The compound of claim 7, wherein R² is hydrogen or methyl.
 9. The compound of claim 8, wherein R² is hydrogen.
 10. The compound of claim 1, wherein R¹, R² and the carbon atom to which they are attached is carbonyl (C═O).
 11. The compound of claim 1, wherein the Z is


12. The compound of claim 11, wherein Z is:


13. The compound of claim 12, wherein Z is:


14. The compound of claim 1, wherein R⁶ is (C₁-C₈)alkyl, substituted (C₁-C₈)alkyl, halo, —OR^(a), —CO₂R^(a), —OCO₂R^(a), —C(═O)R^(a), —OC(═O)R^(a), —NR^(a)R^(b), —C(═O)NR^(a)R^(b), —OC(═O)NR^(a)R^(b), or aryl where substituted (C₁-C₈)alkyl is (C₃-C₈)cycloalkyl(C₁-C₈)alkylene-, halo(C₁-C₈)alkylene-, —(CH₂)₁₋₂OR^(a), —(CH₂)₁₋₂C(═O)OR^(a), —(CH₂)₁₋₂OC(═O)R^(a), —(CH₂)₁₋₂C(═O)R^(a), —(CH₂)₁₋₂OCO₂R^(a), —(CH₂)₁₋₂N^(a)R^(b), or —(CH₂)₁₋₂OC(═)NR^(a)R^(b).
 15. The compound of claim 14, wherein R⁶ is (C₁-C₄)alkyl, chloro, fluoro, phenyl, —OR^(a), —CH₂OR^(a), —CO₂R^(a), —CH₂CO₂R^(a), —OCO₂R^(a), —CH₂OCO₂R^(a), —C(═O)R^(a), —CH₂C(═O)R^(a), —OC(═O)R^(a), —CH₂OC(═O)R^(a), —NR^(a)R^(b), —CH₂NR^(a)R^(b), —C(═O)NR^(a)R^(b), —CH₂C(═O)NR^(a)R^(b), —OC(═O)NR^(a)R^(b), or —CH₂OC(═O)NR^(a)R^(b).
 16. The compound of claim 15, wherein R⁶ is OH, OMe, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, —CH₂OH, phenyl, —OAc, —CH₂OAc, —CO₂H, —CO₂Me, —OCO₂Me, —CO₂Et, —OCO₂Et, —C(═O)CH₃, —CONH₂, —CONHMe, —CONMe₂, —CONMeEt, —NH₂, —NHMe, —NMe₂, —NHEt, —N(Et)₂, or —CH₂N(CH₃)₂.
 17. The compound of claim 16, wherein R⁶ is OH, OMe, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, —CH₂OH, phenyl, —OAc, —CH₂OAc, —CO₂Me, —OCO₂Me, —CO₂Et, ‘OCO₂Et, —CONMe₂, —CONMeEt.
 18. The compound of claim 1, wherein number of R⁶ groups substituted on the Z ring is an integer from 1 to about
 4. 19. The compound of claim 14, wherein R^(a) and R^(b) are independently hydrogen, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, tert-butyl, phenyl or benzyl.
 20. The compound of claim 19, wherein R^(a) is hydrogen, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, isobutyl, or tert-butyl and R^(b) is hydrogen, or methyl.
 21. The compound of claim 14, wherein R^(a) and R^(b) together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring.
 22. The compound of claim 21, wherein R^(a) and R^(b) together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, or morpholino ring.
 23. The compound of claim 1, wherein each R⁷ is independently hydrogen, (C₁-C₄)alkyl, aryl, aryl(C₁-C₈)alkylene, diaryl(C₁-C₈)alkylene, heteroaryl(C₁-C₈)alkylene, or diheteroaryl(C₁-C₈)alkylene.
 24. The compound of claim 23, wherein one R⁷ is hydrogen, and the other R⁷ is hydrogen, methyl, ethyl, 3-pentyl, phenylCH₂CH₂—, (phenyl)₂CHCH₂—, pyridylCH₂—, benzyl, or


25. The compound of claim 24, wherein one R⁷ is hydrogen, and the other R⁷ is hydrogen, 3-pentyl, pyridylmethyl, or benzyl.
 26. The compound of claim 25, wherein each R⁷ is hydrogen.
 27. The compound of claim 23, wherein N(R⁷)₂ is amino, 3-pentylamino, diphenylethylamino, pyridylmethylamino, benzylamino, or a group having the formula:


28. The compound of claim 23, wherein —N(R⁷)₂ is amino, ethylamino, diethylamino, diphenylamino, pentylamino, or benzylamino.
 29. The compound of claim 28, wherein N(R⁷)₂ is amino.
 30. The compound of claim 1, wherein X is —CH₂OR^(a) or —C(O)NR^(a)R^(b).
 31. The compound of claim 30, wherein X is —CH₂OH, —C(O)NHCH₃, or —C(O)NHCH₂CH₃.
 32. The compound of claim 1, wherein m is 0, 1, or
 2. 33. The compound of claim 32, wherein m is 0, or
 1. 34. The compound of claim 1, having the formula

a pharmaceutically acceptable salt thereof.
 35. A therapeutic method to inhibit an inflammatory response comprising administering to a mammal in need of said therapy, an effective anti-inflammatory amount of a compound of claim
 1. 36. A therapeutic composition comprising a compound of claim 1, in combination with a pharmaceutically acceptable carrier.
 37. The composition of claim 36 further comprising a Type IV phosphodiesterase inhibitor.
 38. The composition of claim 37 wherein the Type IV phosphodiesterase inhibitor is rolipram, cilomilast, or roflumilast.
 39. The composition of claim 36, wherein the carrier is a liquid carrier.
 40. The composition of claim 36, which is adapted for oral, intravenous, ocular, parenteral, aerosol or transdermal administration.
 41. A method for preventing or treating a pathological condition or symptom in a mammal, wherein the activity of A_(2A) adenosine receptors is implicated and agonism of such activity is desired, comprising administering to said mammal an effective amount of a compound of claim
 1. 42. The method of claim 41, wherein the mammal is a human or equine.
 43. The method of claim 41, wherein the pathological condition or symptom is caused by autoimmune stimulation (autoimmune diseases), allergic diseases, skin diseases, infectious diseases, wasting diseases, organ transplantation, tissue or cell transplantation, open wounds, adverse effects from drug therapy, a cardiovascular condition, dialysis, gout; chemical trauma, or thermal trauma.
 44. The method of claim 43, wherein the pathological condition is an open wound.
 45. The method of claim 41, wherein the pathological condition or symptom is inflammation.
 46. The method of claim 45, wherein the inflammation is caused by pathogenic organisms.
 47. The method of claim 45, wherein the inflammation is caused by a viral organism.
 48. The method of claim 45, further comprising administration of an effective amount of an anti-pathogenic agent.
 49. The method of claim 48, wherein the pathogen is a bacteria and the anti-pathogenic agent is an antibiotic.
 50. The method of claim 48, wherein the pathogen is a virus and the anti-pathogenic agent is an antiviral agent.
 51. The method of claim 48, wherein the pathogen is yeast or fungus and the anti-pathogenic agent is an antifungal agent.
 52. The method of claim 49, wherein the inflammation is caused by E. Coli.
 53. The method of claim 49, wherein the bacteria causes hemolytic uremic syndrome.
 54. A method to diagnose myocardial perfusion abnormalities in a mammal comprising: (a) parenterally administering to said mammal an amount of a compound of claim 1; and (b) performing a technique on said mammal to detect the presence of coronary artery stenoses, assess the severity of coronary artery stenoses or both.
 55. The method of claim 54 wherein the mammal is a human or equine.
 56. The method of claim 54, wherein said myocardial dysfunction is selected from the group consisting of coronary artery disease, ventricular dysfunction and differences in blood flow through disease-free coronary vessels and stenotic coronary vessels.
 57. The method of claim 54, wherein said technique to detect the presence and assess the severity of coronary artery disease is selected from the group consisting of radiopharmaceutical myocardial perfusion imaging, ventricular function imaging, or techniques for measuring coronary blood flow velocity.
 58. The method of claim 57, wherein said radiopharmaceutical myocardial perfusion imaging is selected from the group consisting of planar scintigraphy, single photon emission computed tomography (SPECT), positron emission tomography (PET), nuclear magnetic resonance (NMR) imaging, perfusion contrast echocardiography, digital subtraction angiography (DSA) and ultrafast X-ray computed tomography (CINE CT).
 59. The method of claim 58, wherein the radiopharmaceutical agent used in conjunction with said radiopharmaceutical myocardial perfusion imaging comprises a radionuclide selected from the group consisting of thallium-201, technetium-99m, nitrogen-13, rubidium-82, iodine-123 and oxygen-15.
 60. The method of claim 59, wherein said radiopharmaceutical myocardial perfusion imaging is scintigraphy and said radiopharmaceutical agent is thallium-201.
 61. The method of claim 57, wherein said ventricular function imaging technique is selected from the group consisting of echocardiography, contrast ventriculography and radionuclide ventriculography.
 62. The method of claim 61, wherein said ventricular function imaging technique is echocardiography.
 63. The method of claim 57, wherein said method for measuring coronary blood flow velocity is selected from the group consisting of doppler flow catheter, digital subtraction angiography and radiopharmaceutical imaging techniques.
 64. The method of claim 63, wherein said method for measuring coronary blood flow velocity is doppler flow catheter.
 65. The method of claim 55, comprising the steps of: (a) administering to said human by intravenous infusion or by bolus injection an amount of a compound of formula I effective to provide coronary artery dilation; (b) administering a radiopharmaceutical agent comprising thallium-201 or technetium-99m to said human; and (c) performing the scintigraphy on said human in order to detect the presence and assess the severity of coronary artery disease.
 66. The method of claim 65, wherein the agent is Tc-99m-sestamibi.
 67. A method for preventing or treating a pathological condition or symptom in a mammal, wherein the activity of A₃ adenosine receptors is implicated and agonism of such activity is desired, comprising administering to said mammal an effective amount of a compound of claim
 1. 